Brief reportSleeping in? The impact of age and depressive sub-type on hypersomnia
Introduction
Terminal insomnia or early morning wakening is one of the so-called ‘endogeneity’ symptoms held to be over-represented in melancholic and psychotic depression. However, we have been struck clinically by the high likelihood of young people with melancholic depression reporting hypersomnia rather than early morning wakening. Similarly, while hypersomnia has long been described (Paykel et al., 1982) as a common ‘atypical’ feature in bipolar depression, we have been again struck by its high frequency in younger bipolar patients, perhaps reflecting the preponderance of melancholic (and psychotic) depression in those with bipolar disorder (Mitchell et al., 2001). Such observations led to the current study, where we sought to determine if hypersomnia was truly over-represented in young subjects with melancholic depression and bipolar disorder and, if so and more importantly, identify when any such sleep pattern might change to the more ‘typical’ pattern of early morning wakening.
Section snippets
Method and material
Data were derived from five consecutive samples of out-patients assessed from 1985 to 2004 at our tertiary referral Mood Disorders Unit, which is weighted to the assessment of those with severe and/or treatment resistant depressive disorders. While assessment was comprehensive, only details relevant to current study components are now provided. The psychiatrist assessed extensive self-report and interview data to make a clinical judgment about the likelihood of any lifetime Bipolar Disorder
Results
Our available sample numbered 1425 subjects across the five studies, with 1412 providing complete data on sleep variables. Inclusion criteria resulted in a sample of 345 patients reporting hypersomnia and 349 reporting early morning wakening (643 excluded for reporting neither or no sleep disturbance, and 88 for reporting both sleep patterns). After aggregating subjects into 10-year bands for their current age, there were relatively few occupying the older bands, so that we did not analyse data
Discussion
Reynolds and Kupfer (1987) observed that almost 90% of patients with a depressive illness suffer from nocturnal awakening, lengthening of sleep latency and early morning wakening. The cause and specificity of such changes are yet to be determined, however, associations with both severity of depression and with melancholia have been reported (Hubain et al., 1996, Stefos et al., 1998).
Description of hypersomnia as a feature of depression is not new, with Goodwin and Jamison (1990) noting that
Acknowledgments
We thank the NHMRC (Program Grant 2223708) and the NSW Centre for Mental Health for study support, and Institute colleagues for study assistance.
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